Procedure.

a.       Who are the parties?

• ·         Robert Chin, (Plaintiff-Respondent and Cross-Appellant)

b.       Who brought the action?

• ·         Dr. Goldfarb
• ·         Nurses Leib,
• ·          Louis-Charles,  Hofgesang,
• ·         St. Barnabas Medical Center and
• ·         C.R. Bard

c.        In what court did the case originate?

• Supreme Court of New Jersey.

d.       Who won at the trial-court level?

• Robert Chin, (Plaintiff-Respondent and Cross Appellant)                                                                                                                                                                                      

e.        What is the appellate history of the case?

Facts.
a.       What are the relevant facts as recited by this court?

• ·         In the present case, the procedure was performed using a Bard Hystero-Flo Pump
• ·         The device is manufactured by defendant C.R. Bard, Inc.
• ·         The pump is energized by gas (Nitrogen).
• ·         In this case, defendants used a supply of nitrogen gas located in the ceiling of the operating room.
• ·         The gas flows from its source to a regulator and from the regulator the gas moves through a tube, the gas line, to the diaphragm pump.
• ·         Gas that has powered the pump then flows out of the system through an open exhaust line into the atmosphere.
• ·         There are two ports in the wall of the scope upstream from the functioning end.
• ·         One port is the inflow port, i.e., it is connected to the line carrying fluid from the diaphragm pump.
• ·         The gas entered through Angelina Chin's body cavity and into her 355*355 circulatory system.
• ·         Air bubbles formed in her blood vessels and killed her almost immediately.
• ·          All parties accept the theory that the exhaust line was the source of the gas which killed Mrs.
• ·         The exhaust line is clipped to the gas line
• ·         the line that carries gas from the regulator to the diaphragm pump. Three clips were hold the exhaust line to the gas line and the last clip is within an inch           of the outflow end of the exhaust line.
• ·         The evidence established that the exhaust line was properly clipped when it left the manufacturer, but the last clip was not on the apparatus when it was                used in the Chin procedure.
• ·         The absence of the last clip caused twenty-seven inches of the exhaust line to hang loose.
• ·         Two nurses the hospital assigned to assist in the procedure
•                     o    Nurse Charles
•                     o    Nurse Leib,
•                                 §  (Both Nurses had no experience regarding the use of the Bard apparatus and had not attended hospital training sessions regarding its                                     use)
•                     o    The supervising nurse who made the assignments was unaware of the experience or lack thereof of nurses Charles and Leib regarding this                                    equipment.
• ·         The evidence also established that, because of their inexperience, Charles or Leib asked nurse Hofgesang to assist them during the procedure.
• ·         Hofgesang reasoning for assisting procedure was because she had some experience with the equipment
• ·         Hofgesang, located to the patient's left, received the apparatus from Charles, the scrub or sterile nurse, who was located on the patient's right.
• ·         Charles had removed the equipment from the Bard package.
• ·          Leib had opened, and handed the apparatus to Hofgesang who connected the tubes to the fluid bags and also connected the hospital's gas line to the               regulator.

b.       Are there any facts that you would like to know but that are not revealed in the opinion?

•         Does the janitorial staff know how to properly handle the machines and equipment?
•         Was the equipment checked the usage prior to the plaintiff surgery?
  
•        Were there any other potential chemical or substances near that could of assist the cause of this embolism?
•        Were the plaintiff allergic to anything?
  
•        Did the plaintiff have a blood disorder?
•        Was the plaintiff on any drugs?
•       
  

Issues.

a.       What are the precise issues being litigated, as stated by the court?

•       Medical Malpractice Suit
•       Liability
  

b.       Do you agree with the way the court has framed those issues?

•        yes

Holding.

a.       What is the court’s precise holding (decision)?
          The defendants are held liable for the negligence of failure to

•               Follow the manufacturer's recommendations for operating equipment.
•              Check equipment for safety prior to use.
•              Place equipment properly during treatment.
•              Learn how equipment functions.

In the fight of discovering who to hold liable consider whether the doctrine of common knowledge, which allows the jury to determine the negligence of professionals without expert testimony concerning professional standards of care, is applicable to this case.

1. What is its rationale for that decision?                   

• The trial court determined that the evidence appropriately enabled the jury to rely on its common knowledge in determining whether any of the defendants breached their duty of reasonable professional care. After the jury had returned its verdict, however, the trial court granted judgment in favor of the hospital and the nurses notwithstanding the verdict, on the basis that it was error to have allowed the jury to consider and rely on its common knowledge in determining the issue of negligence.

1. Do you agree with that rationale, and why or why not?

•        Yes, I do believe that it was a fair trial
  

Implications.

a.       What does the case mean for healthcare today?

• That there should be new policies and procedures implemented to prevent such incidents from reoccurring.
  

b.       What were its implications when the decision was announced?

• The common knowledge doctrine applies when "[t]he facts of a given case [are] such that the common knowledge and experience possessed by lay [persons] ... enable a jury to conclude, without expert testimony, in a malpractice action as in any other negligence action that a duty of care has been breached." Kelly, supra, 300 N.J.Super. at 265, 692 A.2d 552 (citing Klimko v. Rose, 84 N.J. 496, 503-04, 422 A.2d 418 (1980)). The trial of a common knowledge case is essentially the same as an ordinary negligence case, and the jury is permitted to supply the applicable standard of care. Rosenberg, supra, 99 N.J. at 325, 492 A.2d 371 (citations omitted).
  

c. How should healthcare administrators prepare to deal with these implications?

• Enforced practice of police of procedure which should state that Failure to use equipment in a responsible manner, including failure to
  
  •  Follow the manufacturer's recommendations for operating equipment.
  • Check equipment for safety prior to use.
  • Place equipment properly during treatment.
  •  Learn how equipment functions.
  Termination or suspension will be enforces.
  

d.       What would be different today if the case had been decided differently?

• Standards such as hospital policies have evolved to protect consumers from substandard care. In defining acceptable levels of care-the ordinary and reasonable care required to ensure that no unnecessary harm comes to patients 2 -standards of care provide criteria for determining whether a nurse has breached duty in the care owed to the patient. Standards of care are derived from sources such as state boards of nursing, professional nursing associations (for example, the ANA and the National League for Nursing), hospital policies and procedures, and the guidelines of federal organizations (for example, JCAHO and the Centers for Medicare and Medicaid Services).